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the hypothetical cause of amblyopia and, since that alkaloidwas freely soluble in water, that not improbably water mightbe made to aid in the elimination of the poison. Withthat object in view his patients were directed to dress

warmly and to drink one pint of warm water at 7 A.M. and towalk briskly for 30 minutes in the open air ; then to drink asecond pint and to walk briskly in the open air for another30 minutes, after which to rest for a few minutes and then totake breakfast. A third pint should be taken in the middleof the morning and a fourth in the middle of the afternoon.Some of the patients during convalescence smoked a

quarter of an ounce of tobacco a day and in three casespractically normal vision was secured in about 14 days, whilstaccording to some of his notes patients under the strychninetreatment were as long as 12 weeks in obtaining an equallygood result. As regarded the effect of the water treatmenton tachycardia, he had not had an opportunity of tryingit as the new cases of amblyopia that had come under histreatment during the last eight weeks had only a very slightacceleration of the pulse-rate but unquestionably it hadnot disappeared in the same way as the amblyopia. He

thought that there was considerable doubt as to the methodof elimination of nicotine. It was excreted by the kidneys,the lungs, and the skin ; he thought mostly by the kidneys,others by the breath, and others by the skin, but the watertreatment had this advantage, that it utilised all threemethods.

Mr. E. TREACHER COLLINS and Dr. RAYNER D. BATTENcommunicated a paper on Neuro-fibroma of the Eyeball andits Appendages. The case which formed the basis of this

paper was that of a girl, aged 14 years, who had beenunder Dr. Batten’s observation since January, 1902. Her

right eye was buphthalmic. The cornea was large andhazy and the anterior chamber was very deep. Thevision equalled -61U. There was also marked hypertrophyof the upper eyelid, the skin of which was coarse and

thickened, and there was a soft doughy swelling overthe right temporal fossa. The condition dated from birth.The eye being very unsightly and irritable was excised, aswas also a wedge-shaped piece of the thickened upperlid. Microscopical examination of the latter showed ex-

tensive overgrowth of the fibrous tissue of the corium andmarked enlargement of the nerves due to thickening of theirperi- and endo-neurium. The condition was evidently one ofcongenital elephantiasis associated with plexiform neuroma,a condition to which the convenient term neuro-fibromatosiswas applied. The chief interest of the case consisted in thecondition of the eye. This made the fourth case which hadbeen recorded in which neuro-fibromatosis of the eyelid hadbeen associated with a buphthalmic condition of the eye.The buphthalmic condition of the eye did not, however,seem to be due directly to fibromatosis of the ciliary nervesbut to increased tension from obstruction to the exit offluid. In the present case and another one which Mr. Collinshad examined he found congenital adhesion of the root ofthe iris to the back of the cornea blocking the filtrationarea. The terminal filaments of the nerves in the corneawere, however, found thickened; they could be seen bythe naked eye as grey lines and microscopically as cordsof elongated cells. The condition of the choroid in thiscase was most remarkable and presented appearanceswhich did not seem to have been described previously.Throughout its structure was denser than normal andin parts it was considerably thickened. Microscopicallythe blood-vessels in it were few and inconspicuous. It was

composed of fibrous tissue arranged in layers, highlynucleated, and with many pigmented cells between them.In some places there were numerous small oval bodieswhich presented the appearance of enlarged nerve-end

organs. In conclusion, by a comparison of this case withthe few others recorded it was shown that all portions of theciliary nerves supplying the eye might be affected by thiscongenital fibromatosis and that in the uveal tract, as in theskin, associated with the neuro-fibromatosis there might be ageneral hyperplasia of the fibrous tissue of the part. Theextent, however, of the affection varied in its distribution,sometimes being confined to one set of ciliary nerves andthe part supplied by them and sometimes to another. Insome cases only the terminal filaments and end organs of thenerves were involved and in others the larger trunks werealso affected.

Mr. A. OGILVY (Bristol) reported a case of Large Exostosisremoved from the Orbit. The patient was a healthy man,aged 24 years. There was no previous history of any ailments

and there was a healthy family history. The patient wasfirst seen last November ; he did not know there was any-thing in his orbit-he merely came because of epiphora. Alarge hard mass was felt in the right orbit, evidently grow-ing from the nasal side. Skiagraphs were made showingwell the extent of the tumour which was evidently causingmyopia and some form of choroidal change. The operationwas performed on Jan. 1st, 1905. Great difficulty wasexperienced in removing the tumour which, however, provedto be pcdunculated and measured over an inch in eachdirection. Recovery after operation was rapid, union beingby first intention. The only trouble was diplopia, causedby complete immobility of all the muscles ; this passed off ina fortnight.

Mr. EDGAR STEVENSON also described a case of Exostosis ofthe Orbit. The patient, a girl, aged 22 years, went to theLiverpool Eye and Ear Infirmary on Nov. 20th last with well-marked downward and outward proptosis of the left eye.She stated that the prominence of the eye had been firstnoticed six months previously and that it was rather rapidlyincreasing. She had no pain except an occasional neuralgictwinge, the movements of the eye were quite free, and she wasnot troubled with diplopia. Her vision in each eye was normalwith correcting glasses, as also was the fundus of each eye.Digital examination under chloroform revealed a small hardmass lying under the outer and upper margin of the orbit.Three weeks later Mr. Stevenson decided to operate andon Dec. 10th the patient was again put under chloroformand the tumour was exposed. It was found that thegrowth was much larger than was to be expected fromthe previous examination. It seemed to be attached tothe inner angle of the orbit with its base in the frontalsinus and to extend right across the roof of the orbit.Two attempts to drill through the more prominent partfailed on account of the drills breaking and Mr, Stevensonthen attempted to chisel through the frontal sinus in orderto expose the base. A small part of the tumour herebecame detached and showed cancellous structure underneatha hard outer shell. There appeared to be some shake" "in the tumour during the chiselling which seemed to indicatethat the point of attachment was not very large, so havingascertained that there was not any apparent involvement ofthe roof of the orbit the tumour was seized with a pair ofbone forceps and wrenched out without difficulty. It was ofirregular pear shape, weighed 351 grains, and its dimensionswere one and a half inches by one and three-eighths inchesby seven-eighths of an inch. The patient made an un-interrupted recovery and her vision, muscular balance, andophthalmoscopic appearances are normal.

ROYAL ACADEMY OF MEDICINE INIRELAND.

SECTION OF MEDICINE.

Paratyphoid Fever.-Large White Kidney.A MEETING of this section was held on Jan. 20th, Sir

J. W. MooItE being in the chair.T""B. -’,....",...." - -. - - --. , , J"1 - - -1 - --

Dr. A. R. PARSONS read notes on three cases of con-

binued fever in which for some time the diagnosiswas obscure. They all occurred in the same buildingand at about the same time. The first proved to bea severe case of typhoid fever and gave a definite Widalreaction with Eberth’s bacillus typhosus on the twelfth dayof the illness. The pyrexia lasted for 50 days. The secondcase, though tested on three separate occasions by differentstrains of bacillus typhosus, gave no reaction but gavevery definite clumping with Gartner’s bacillus enteritidison two occasions and with different strains. The pyrexialasted for 21 days. Case 3 was also negative withbacillus typhosus but positive with Gartner’s bacillus. The

pyrexia lasted for 14 days. In all the cases the subjectivephenomena were headache and malaise. The objective signswere temperatures of from 102° to 1040 F., while the averagepulse rate was only 90. In none of the cases was the spleenpalpable and only in the first case were any spots visible.Cultures were made from the urine and fasces in the lattercases but the bacillus enteritidis was not isolated. Dr.Parsons referred to cases of paratyphoid fever reported inbhe American Journal of the Medical Sciences and pointed outthe necessity for isolating various strains of the bacilli ofparatyphoid fever against which the blood of obscure cases

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of continued pyrexia might be tested. Owing to the general 1absence of ulceration in paratyphoid fever he was of opinion that the diet need not be quite so strictly regulated as in 1

typhoid fever.-Dr. J. CRAIG described minutely the fatal ’ ’.case of paratyphoid fever which he had seen. The patient was a man whose appearance suggested typhoid fever. His 1

temperature was 103.2° F. and his pulse and respirations awere 100 and 24 per minute respectively. He had three

liquid yellow motions and developed a rash which at first i

consisted of rose spots but later became dark, like that oftyphus fever. The tongue was thickly coated, the cerebration was slow, and he refused food. The abdomen was distended. l

He became delirious and 17 days after the rigor which hadushered in the illness he died. The pulse averaged from 95 to100 and the respirations 24 per minute respectively. The

spleen was easily seen to be enlarged. At the necropsy noevidence of enlargement or ulceration of Peyer’s patches wasfound but the greater part of the ileum was in a state ofacute inflammation. Dr. White examined the blood on thefourth day after admission. He tried a Widal reaction andobtained clumping with a dilution of 1 in 25. There wasno evidence of Eberth’s bacillus but one of the forms ofbacillus enteritidis had caused the illness. In a number ofcases haemorrhage from the bowel had been observed.-Dr.R. TRAVERS SMITH said he had seen two cases which hethought were paratyphoid fever. One of them was a woman,aged 32 years. On admission to hospital her temperaturewas 103° F., her pulse was not markedly quick, there was nodiarrhoea or enlarged spleen, and there were no rose spots,but there was great abdominal distension and she wasrather livid. The blood was negative to Widal’s reaction.She died in about a week and at the necropsy not a trace ofdisease was found in Peyer’s patches, neither was the spleenenlarged. In the other case the tongue was coated, thespleen was a little enlarged, the pulse was rather quick, andthe temperature was raised. The blood was negative to

Widal’s reaction. The fever gradually subsided but for tendays the spleen remained large, then it subsided, and she gotperfectly well. He suspected paratyphoid fever but had noproof of it, as the special blood reaction had not been testedfor.-Dr. G. E. P. MELDON thought that in paratyphoidfever the diet ought to be regulated as carefully as in

typhoid fever, for in some cases there had been haemorrhagesshowing disease of the intestine. The presence of a

large ulcer had been reported in one case.-Dr. E. M.FANNIN said that he once had under his care a youth,aged 17 years, who suffered from a continued fever thecharacters and course of which were the same as those of

typhoid fever. There were no rose spots and no enlargementof the spleen but there was acute laryngitis. At that timethe Widal reaction was negative. Ten days after the

temperature had become normal a relapse occurred. It pre-sented the features of typhoid fever, the laryngeal symptomswere renewed, rose spots appeared, and the spleen becamepalpable. The patient became very ill and was removed to

hospital. Two or three days afterwards symptoms of per-foration occurred. An operation was performed and a per-forated ulcer was discovered. The patient did not recover.Dr. Thompson was satisfied that the ulcer was like an

ordinary typhoid one. In that case, then, repeated examina-tions of the blood had failed to give the Widal reaction.The course of the illness resembled typhoid fever and afatal result occurred after perforation, therefore it was

possible that some forms of paratyphoid fever could have thedefinite ulceration of Peyer’s patches.-Dr. KIRKPATRICKsaid that he would like to ask whether any differentiation hadbeen made in the clinical history of the fevers which weredue to the different groups of paratyphoid bacilli.-Pro-fessor E. J. MCWEENEY discussed the cases from a patho-logical point of view. He said that he would be inclinedto describe Dr. Parsons’s second and third cases as cases ofinfection with Gartner’s bacillus. It had been mentioned thatthe blood serum failed to agglutinate cultures of the typhoidbacillus but agglutinated cultures of Gartner’s bacillus. Thatcarried an indication of infection with Gärtner’s bacilluswhich was not quite the same thing as paratyphoid fever.Gartner’s bacillus was not quite the same type as thealpha and beta groups of paratyphoid bacilli but presentedcertain differences. It was quite possible that the secondand third cases were paratyphoid fever but the bacilli wouldhave had to be isolated and their characters fully tested.What he found lacking in the pathological description was astatement of the different dilutions which were employed.-Dr. PARSONS, in the course of his reply, said that intestinal

lesions had been mostly found to be in abeyance duringparatyphoid fever and he thought that in it restriction ofthe patient’s diet was not so necessary as in typhoid fever.There was no difference in the clinical course of the feversproduced by the alpha and beta groups. In his communica-tion he had used the term paratyphoid in its widest senseand included Gärtner’s bacillus in the term, although he wasaware that there was a tendency to restrict the term to asmall group of bacilli.

Dr. G. PEACOCKE described the clinical history of twocases of Large White Kidney which had been recently underhis care. The symptoms of each case were very similarand were briefly amcmia, universal dropsy, diarrhoea, andscanty, highly albuminous urine containing numerous casts.-Professor MCWEENEY, Dr. TRAVERS SMITH, and otherstook part in the ensuing discussion.

BRITISH GYNECOLOGICAL SOCIETY.-A meetingof this society was held on Feb. 9th, Dr. William Alexander,the President, being in the chair.-Dr. H. Macnaughton-Jones read notes of a case of Ascites with Pelvic Symptomswhich proved to be due to a typical fibroma of the leftovary ; the tube was not involved and the adnexa on the

opposite side were healthy.-Dr. Macnanghton-Jones alsoread notes of a case of Carcinoma of the Ovary in whichthere had been neither pain nor any evidence of malignancyup to within six weeks of the operation which was

undertaken for parametritis and peritonitis. The tumour

(exhibited) was adherent to a myomatous uterus in frontand to the intestine and rectum behind; neither tubewas involved, nor the other ovary. There was no ascites.-After the discussion on these specimens the Presidentdelivered his Inaugural Address, embodying his own expe-rience of the rise and progress of gynaecology. When hewas a student there was no gynaecology worthy of the name.The abdomen belonged to the physician and "inflammation"was a name which included many diseases which were nowtreated successfully by the surgeon or the gynæcologist. Ab-dominal tumours were, in the first instance, referred to thephysician and only when medical measures failed was thecase handed over to the operator. Whilst the physiciantreated all the internal diseases of the abdomen the obstet-rician repaired any damage caused by parturition. But theobstetricians had but small experience in surgery and did notoften care to undertake it and so these cases passed into thehands of the general surgeon. Gynaecology afterwards learnedfrom medicine the mutual action of the genital organs andthe rest of the system ; from obstetrics the changes due topregnancy ; but it was to surgery that the greatest advancesof the past 50 years were due. Surgery and gynæcologyhad so much in common that a knowledge of the former wasnecessary for the successful practice of the latter. Theearlier gynecologists were not surgeons but were experts inthe application of pessaries and many were rememberedowing to the instruments bearing their names. No examina-tion was considered complete without the use of sound andspeculum, instruments which bimanual palpation had ren-dered obsolete save for some specific purpose. One of the mostserious operations of that day was perineorrhaphy, as shownin a report of 12 cases with two deaths. Abdominal operationswere rarely performed and generally ended fatally. Yet the

surgery was excellent and some operators, by instinctivesurgical cleanliness, obtained much success. There was,however, no guide until Lister enunciated the germ theoryof disease. The extensive use of carbolic acid followedand worked wonders in general surgery. In 1877, whenLister came to London, Spencer Wells had reducedhis mortality from 25’ 5 to 9 per cent. ; with thecarbolic spray he got still better results. Soon dis-

Esatisfaction was expressed at the irritation of thetissues caused by antiseptic dressings. Meanwhile bacterio-

logy had developed and hence arose the aseptic system of; treating wounds. It was asepsis which explained the successof Wells, Tait, Bantock, and other apostles of cleanliness,

who, without admitting the germ theory, had unwittingly: lighted upon the practice of aseptic surgery. This was theL highest development of the germ theory and by no class of operators was it carried out more strictly or more successfullyl than by gynaecologists. To the patient aseptic surgeryafforded greater comfort and safety, to the surgeon moreL certainty and greater success. The knowledge thus ac-

- quired once belonged to a few special men but had nowl become diffused throughout the country and aseptic

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gynaecology was brought, as it were, to the doors of

patients. He had been surprised at the excellence ofthe gynaecological as well as surgical work performedin small hospitals and the valuable assistance that couldnow be obtained in distant places from men whose sur-

gical instincts were kept fresh and keen in such hospitals.There were other improvements which ’had accentuated thesuccess of both antiseptic and aseptic gynascology. Fore-most amongst these was the Trendelenburg position in pelvicoperations, then the avoidance of post-operative hernia bythe methods of closing the abdominal wall, and the value oftime in diminishing shock was well understood. Gynaecologystill afforded an unexhausted field for future research andeffort as long as the present high mortality of cancer of theuterus continued. Again, the nervous diseases of womenrequired further study and the conditions, too oftenerroneously attributed to neurasthenia or hysteria, requiredto be classified and their treatment formulated. Their

present treatment of uterine displacements could hardlybe termed rational ; it would not be tolerated in the

displacements of other organs. The causes of many formsof displacement were involved in obscurity and urgentlyrequired elucidation.

THERAPEUTICAL SOCIETY.-A meeting of thissociety was held at the Apothecaries’ Hall, London, E.C.,on Jan. 24th.-Dr. W. E. Dixon (Cambridge) read a paperon the Action of Alcohol on the Heart. He said thatalcohol was thought of by some as a stimulant, by others asa depressant, but substances such as thyroid extract, whichproduced little effect on health, might improve nutrition indisease. The action of alcohol was considered : (1) on therate of the pulse ; (2) on the heart itself ; (3) on the blood-vessels ; and (4) on the blood pressure. In small quantitiesand in a concentrated form it decidedly quickened the

pulse at first but had no effect if it was much

diluted ; in very large doses it slowed the pulse. Its

quickening action depended on its irritating effectson the mouth and stomach, like that of ammonia ’,or even burnt feathers in fainting, but concentratedalcohol was more powerful than either. In too great aquantity it depressed the medulla. If chloroform was first

given the stimulating effect was prevented. The heart wascaused to contract more powerfully by alcohol at first thoughif much chloroform was first administered the heart becamefatigued and did not respond to the stimulative power ofalcohol. The internal vessels were constricted by the actionof alcohol, as might be shown by the oncometer, the arm’shrinking in bulk 15 or 20 minutes after it had been taken.This constriction drove the blood to the superficial vesselsand caused the flushing of the face. Alcohol increased theblood pressure by stimulating the heart and constricting thevessels. Dr. Dixon summed up his remarks by saying thatalcohol in small concentrated doses increased the rate of thepulse and the systole of the heart, constricted the deepervessels, and increased the blood pressure, especially whenthe heart’s action was feeble ; it was therefore of greatservice in cases of fainting. If much diluted it had littleeffect on the heart but acted as a food, replacing starchin maintaining the heat of the body. In too largedoses it depressed the heart.-Dr. H. A. Caley reada paper on Some Points in the Actions and Uses ofBismuth Salts, referring principally to the three insolublesalts in common use-the subnitrate, salicylate, andcarbonate. Their local action on the stomach was first

considered, their mechanical, astringent, and antisepticproperties were then discussed, and reasons were adducedfor regarding the local action on the mucous membrane asthe most important factor, their special usefulness in gastritisand ulcer being emphasised. Of the three, the carbonatewas the most generally useful as a gastric sedative. In

dealing with the action of bismuth salts in intestinaldisorders Dr. Caley brought forward experimental evidencebearing on the antiseptic action of the three salts ; thesubnitrate had definite germicidal action on cultures of thebacillus coli, the salicylate a similar but much weaker effect,while the carbonate was inert as a germicide. Under

laboratory conditions this antiseptic action of the first twosalts was destroyed by alkalies ; on the other hand, thera-peutic experience showed that an alkaline medium did notdestroy their efficacy. For this and other reasons it wasinferred that the principal action of bismuth in the intestineswas a local action on the mucous membrane and that thepresence of catarrhal inflamynation was one of the chief

’ indications for its employment. If given in sufficiently’ large doses bismuth was potent in many intestinal disordersand was capable to a large extent of replacing the more

direct intestinal antiseptics, strong astringents, and opiates.Of these three salts the subnitrate was the most efficacious inirritant lesions of the intestines and where a more markedastringent effect was desired he preferred a combination ofthis salt with catechu or other vegetable astringents to themore recently introduced subgallate of bismuth.

LIVERPOOL MEDICAL INSTITUTION.-A patho-logical meeting of this society was held on Feb. 9th, Dr. JamesBarr, the President, being in the chair.-Mr. W. ThelwallThomas and Dr. E. Cleaton Roberts showed two specimens ofMultiple Villous Growths of the Bladder removed frompatients aged 56 and 60 years.-Mr. Thomas also showedtwo specimens of Volvulus. One was in a woman, aged56 years, and included 15 inches of large and three inchesof small intestine. The stump had a complete turn fromleft to right with a gangrenous convexity. The other wasin a woman, aged 22 years, in whom 18 inches of gan-grenous small intestine were removed. Specimens from athird abdominal case exhibited by Mr. Thomas showedthe ovary and Fallopian tube to form the walls of an

abscess cavity to which were attached four inches of gan-grenous small intestine. These were resected and end-to-end anastomosis was performed.-Mr. J. Douglas-Crawfordshowed Microscopical Preparations of Actinomycosis fromthe jaw and from the skin.-Dr. R. J. M. Buchanan showed aMegasphere from a case of carcinoma of the lung.-Dr.Nathan Raw showed specimens of Primary Tuberculosis ofthe Kidney with Secondary Affection of the Bladder.-Dr. W.Blair Bell showed Radiographs (by Dr. C. Thurston Holland)of a case of Morton’s Disease before and after treatment whichconsisted in the excision of the fourth metatarso-phalangealjoint and had resulted in complete cure.-Dr. Ernest E. Glynnshowed a greatly Dilated (Esophagus from a man withsymptoms of stomach disease; the necropsy showed, however,that the stomach was contracted and the cause of the dilata-tion remained obscure ; there was no microscopical change inthe musculature of the œsophagus,-Dr. Glynn also showeda Thrombosed Pulmonary Artery which had caused death ina boy a few hours after a perfectly successful operation forappendicitis.-Dr. A. W. Campbell read a note on TuberoseSclerosis of the Brain, a very rare but well-definedcondition consisting of a peculiar hard whitish appearanceon certain areas of the cortex ; these were not raisedand did not infiltrate below the level of the immediatewhite matter. Microscopically they showed a gliastructure and branched tubular glandular structureslined by columnar epithelium. Giant nerve cells were

also seen. In the kidneys were myo-fibromata and onthe skin soft tumours called adenoma sebaceum. The

patient was an epileptic idiot, aged 27 years.-Dr. G. G.Stopford Taylor and Dr. F. H. Barendt spoke of havingseen this condition of the skin in mentally defective personsand Mr. E. M. Stockdale and Dr. W. B. Warringtondiscussed the nature of the gland like structures.-Dr.C. Thurstan Holland read a note on the X Ray Diagnosisof Kidney Stones and showed a " Diaphragm Com-

pressor" " designed by himself. By the use of such a

compressor the movements of the kidney during respi-ration were controlled, much sharper definition was

obtained, and good negatives might be readily produced.By this method the negative diagnosis was made moresure-a point of very great importance. The note-was illustrated by a series of lantern slides showingstones in the kidney. One slide showed an oxalate stone-which when removed was found to weigh two grains, whilstanother slide showed a uric acid calculus which weighedfive grains.-Dr. Buchanan gave an account of a Method ofStaining the Blood Elements, designed to show a differencein the staining characteristics of the red cells of perniciousanaemia. He also gave an account of the centrosome andattraction sphere of cells.LARYNGOLOGICAL SOCIETY OF LONDON.-A meeting

of this society was held on Feb. 3rd, Mr. Charters J.Symonds, the President, being in the chair.-Mr. C. A.Parker showed a case of Tuberculosis of the Larynx in a. ,woman, aged 31 years. The disease commenced duringher fourth pregnancy, since which she had been pregnantfive times. On three occasions the child was born alive andon two occasions she had miscarriages.-Mr. H. Clayton Foxshowed, for Dr. Frederick Spicer, a case of Diffuse Papilloma

433

of the Vocal Cords; and Dr. Edward Law showed a man, Gastrojejunostomy." He observed that as to the choice of

aged 69 years, from whom a Laryngeal Growth was removed operation the two main methods open to the surgeon were21 years ago from the right vocal cord by the late the anterior and the posterior operation, the object of eitherDr. Whistler. Views as to the present condition were being the provision of an efficient anastomosis with the smallinvited. Some members were of opinion that the case intestine to short-circuit the pylorus, the most importantwas malignant but the general feeling was that this technical points being the insurance of an opening ofwas not so.-Mr. P. R. W. de Santi showed two cases, sufficient size and that this should be at the most dependentthe first being that of a woman, aged 39 years, exhibited part of the stomach. What is the most dependent part ofat the last meeting, with a laryngeal swelling which was the greater curvature? By the aid of diagrams this wasthought to be tuberculous but a microscopical slide shown to be beneath the left rectus muscle. The stagesnow showed that it was undoubtedly squamous-celled of the operation were then reviewed. In preparing thecarcinoma. The second case was that of a man, aged 60 patient it was desirable to wash out the stomach for two oryears, with a large mass of Malignant Glands in the Neck three days prior to operation but not on the day of opera-and Swelling of the Larynx on the same side.-Mr. Stephen tion. The skin should be shaven dry, ether soap rubbed in,Paget showed three cases for diagnosis. The first was a and the skin scrubbed lightly with a brush, the soap removedcase of Fixation of the Left Vocal Cord; the opinion of with clean swabs, and ether or turpentine applied. Anthe meeting was that this was due to aneurysm. The second incision from three and a half inches to four inches long wascase was one of Growth of the Right Ventricular Band. The made through the left rectus muscle. A small incision wasthird was one of Growth in the Larynx which was generally best as a slight amount of plugging only was then necessary.regarded as papillomatous though some members inclined to The stomach was drawn out and a search was then made forthe view that it was malignant.-Mr. F. J. Steward showed the piece of jejunum wanted. The two pieces of bowel werea case of Recurrent Ulceration of both Tonsils associated then clamped with Doyen’s clamps. A simple running suturewith Lymphadenoma in a woman, aged 64 years.-Dr. F. W. carried obliquely across was the best as it equalised theBennett showed a specimen and photographs of a Malignant tension between the sutures and controlled haemorrhage. AGrowth of the Larynx and a case of Nasal Ulceration of the fine silk suture sufficed. The clamps and plugs having beenSeptum for diagnosis. The latter was considered to be a removed the abdominal wound was closed and collodioncase of ethmoiditis.-Dr. Herbert Tilley showed a case of applied, and it was then covered with gauze soaked in a

Primary Sore on the Tip of the Tongue in a man, aged 40 mixture of gelatin and salicylic acid to which some formalinyears. There was slight enlargement of the glands but no (one drachm to an ounce) had been added. Two days’ rectalrash. Some doubt was expressed whether it was not a feeding was enough. The dressing was comparatively nil.

simple granuloma resulting from the irritation of the Regurgitant vomiting was the chief after-trouble. Thecaustics which the patient had repeatedly applied.-Dr. possible explanations were : (1) the intestine had not beenG. C. Cathcart exhibited two cases, the first being that of a attached to the lowest part of the stomach; (2) the mucouspatient shown at a previous meeting, with Pachydermia membrane was redundant and a valve was formed which

Laryngis (?) Tuberculous; and the second being a case of prevented the flow from the stomach to the intestine ; andCombined Functional and Organic Paresis of the Larynx (3) the opening was too small. Some regurgitation alwaysin a singer, aged 34 years. took place and usually did no harm. The indications for the

DERMATOLOGICAL SOCIETY OF LOND0N. - A operation were : 1.. Pyloric obstruction. In pyloric obstrnc-

meeting of this society was held on Feb. 8th, Dr. J. J. tion due to carcinoma it could be done in any case if

Pringle being in the -chair.-Dr. T. Colcott Fox showed sufficient room was left by the disease. The condition of

(1) a man, aged 50 years, who had lived in India and the patient was sometimes a bar, and this was where the

who, six months after his return to England, had developed mortality of the operation came in. The relief was temporarya generalised pruriginous eruption all over the body and but this objection was much less than the similar objectionlimbs. There were to be seen small infiltrated obtuse which might be raised against colotomy. Where there was

papules situated rather deeply in the skin, showing no group- ulceration of the growth the relief from pain was very

ing and not developing into vesicles. The case resembled both great. 2. Cicatricial contraction. Here the operation was

the prurigo of Hebra and the eruption described under the sometimes absolutely simple and successful but in other

name of pseudo-leukæmic prurigo, but there were no enlarged cases it was a troublesome one. 3. Congenital hypertrophicglands or any signs of lymphadenoma. (2) A man who was stenosis. In these cases it was not a good operation, the

suffering from an attack of Ordinary Eczema of the Lumbar intestine being too thin and tenuous, and the results hadRegion but in whom were found accidentally, on stripping been bad. 4. As an operation of expediency. The operationthe back to view the eczema, many large nodes situated

had been widely recommended and practised for gastricdeeply in the hypoderm over the last two ribs on the left

dilatation of unknown causation, for simple gastric ulcer, andside. The question was, Were these gummata or some kind

for gastric and duodenal hemorrhage It has been recom-

of true tumour formation ? They had been in existence mended on the grounds of securing physiological rest. Byfor six years. The majority of members thought that the freer drainage of the gastric contents it was said to

they were probably gummata.-Dr. Pringle showed a man, relieve pyloric spasm. Again the ulcerated surface was lessaged 64 years, with Extensive Symmetrical Sclerodermia irritated; hence there were relief from pain and less chanceof seven years’ duration. The patches extended over almost of hæmorrhage Cases were quoted these operations mainlythe whole of the legs below the knee, on the thighs, over due to errors of diagnosis and after these commonly to thethe area roughly corresponding to the second lumbar seg- failure errors operation to and perhaps was expected of it.ments according to Head, and from the styloid processes of failure of the operation to perform what was expected of it.the ulnoe up to the tips of the olecrana, thus corresponding OTOLOGICAL SOCIETY OF THE UNITED KINGDOM.-to the first dorsal nerve areas.-Dr. J. Il. Stowers showed a A meeting of this society was held on Feb. 6th, Dr. Thomascase of Mixed Sclerodermia. The disease started eight years Barr, the President, being in the chair.-The Presidentago with the appearance of a patch on the left breast and delivered an address in which the spoke at some lengthsubsequently two more patches appeared in the neighbour- on the an address research he spoke at some lengthhood of this. Two years ago the left arm began to waste

on the institution of research work and the formation of

and when shown there was extensive sclerodermia with a Permanent museum in connexion with the society. He

rigidity and partial immobility of the elbow-joint from the said that since the time of loynbeethe pathological anatomycontraction of the skin. Most of the patches showed the of the ear had not received adequate attention in this

characteristic ivory-white appearance but in some situations country, ihe pathologist habitually ignored it in the

there was marked telangiectasis.-Dr. F. Parkes Weber post-mortem room and yet there was probably no partshowed a well marked case of liaposi’s Idiopathic Pigmented

of the body in which a thorough examination was

Sarcoma in an elderly man, with sections from one of the more important in the interest of progress. The thoroughgrowths. The usual marked oedema and almost purple examination of the temporal bone and organ of hear.

colouration of the limb were present. ence however, required more time and technical experi-ence than fully occupied otologists could usually com-

SOUTH-WEST LONDON MEDICAL SOCIETY.-A mand. Moreover, the operative work which they had to

meeting of this society was held at the Bolingbroke perform rendered it perhaps undesirable that they shouldHospital, Wandsworth Common, on Feb. 8th, Mr. E. F. engage in post-mortem investigations. He therefore sug-White, the President, being in the chair.-Mr. G. H. gested that it might be possible to make arrangements byMakins gave an address entitled ,. Some Remarks on the which temporal bones sent by any member of the societyIndications for, and the Results of, the Operation of might be examined anatomically and pathologically by young

434

men specially interested in otology and possessed of therequisite knowledge for conducting such researches. A per-manent museum would be a great addition to the resourcesof the society, for otology lent itself to the productionof anatomical and pathological specimens.-A discussionthen took place on Mr. Charles J. Heath’s address, entitled" The Restoration of Hearing after Removal of the Drumand Ossicles by a Modification of the Radical MastoidOperation for Suppurative Ear Disease." This address wasdelivered before the society on Dec. 5th, 1904, and waspublished in THE LANCET of Dec. 24th, p. 1767. Severalspeakers said that the operation described was practically theone already known as Stacke’s, or the Schwartze-Stacke,operation.-Mr. Heath, in his reply, said that he had referredto his operation as a modification 4of Stacke’s operation.The only statistics which he could quote were as follows:average duration of treatment before operation, 13 months ;average duration of the disease, 15 years ; proportion ofcases with improved hearing, 84 per cent.-Dr. WilliamMilligan read notes of two cases of Labyrinthine Suppurationrecently operated on, with special reference to the path ofinfection. The patients were males, aged respectively 37 and46 years. In both of them the duration of the disease wasat least 20 years and the result of the treatment was com-plete recovery.-Dr. Herbert Tilley read notes of a case ofAcute Labyrinthine Suppuration in a male patient, the sub-ject of chronic otorrhaea. The radical mastoid operationwas performed and recovery followed.-Mr. L. Lawrenceshowed a patient suffering from Chronic Non-suppurativeMiddle-ear Disease, in whom a mere touching of eithertympanic membrane produced marked and rapidly extendinghyperasmia. The condition might be called "urticaria ofthe drum."-Mr. Arthur H. Cheatle exhibited 250 TemporalBones obtained from patients at all ages ; these bones weresectioned vertically through the antrum and mastoid process.- Mr. Hunter F. Tod read notes of a case of Hernia Cerebri etCerebelli the result of acute encephalitis. The patient wasa boy, aged ten years, in whom acute middle-ear symptomsdeveloped in June, 1904. Schwartze’s operation was per-formed and seven days later the hernia was discovered.Gradual recovery followed and hearing was now normal onthe affected side.-Other patients were shown by Mr. ErnestB. Waggett, Mr. Richard Lake, and Dr. H. M. Macnaughton-Jones.

HUNTERIAN SOCIETY.-A clinical meeting ofthis society was held on Feb. 8th, Dr. F. J. Smith beingin the chair.-Dr. Parves Stewart showed a case of Oculo-motor Paralysis of the Eye of a woman suffering fromtertiary syphilis. She was rapidly recovering under treatmentwith iodides and mercury but still exhibited divergentstrabismus and weakness in the action of the superior,inferior, and internal recti muscles, a dilated pupil, and weak-ness of accommodation. Ptosis was also present with cor-ragation of the forehead on the same side, a sign which wasnot present in hysterical ptosis. The gummatous process prob-ably affected the nerve at the point at which it pierced thedura mater.-Dr. Stewart also showed a case of CervicalSympathetic Paralysis due to division of the second and thirddorsal roots on the right side by a Mauser bullet in the Boerwar. The pupil was contracted on the same side and didnot dilate on shading from light or pinching the lobule ofthe ear. The eye was sunken into the orbit owing to

paralysis of Muller’s muscle. There was ptosis to a slightdegree on the same side for the plain muscle fibres in theupper lid were paralysed. The area of sweat fibres

supplied by the cervical sympathetic had been markedout on this man and had been found to be theexact half of the head and neck, the front of thechest as low as the nipple and the back as far down asthe lower angle of the scapula and the whole of the upperlimb. The man was induced to sweat. Then charcoal was

puffed over him and adhered to the sweating area. The areaof paralysis was dry and the charcoal did not adhere. The

patient was then photographed and these photographs wereshown to the meeting. Photographs exhibiting spasm ofthe sympathetic from a case of Graves’s disease were alsoexhibited for contrast.-Dr. Smith, Dr. W. Langdon Brown,Dr. R. Hingston Fox, and Mr. Harold L. Barnard took

part in the discussion of the cases.

ROYAL MEDICAL SOCIETY, EDINBURGH.-A meet-ing of this society was held on Feb. 10th.-Dr. F. W. N.Haultain read a paper on Fibroid of the Uterus. Hesaid that he divided fibroids into two classes-those

, which gave rise to symptoms and those which did not-and, he stated that the condition was more common than one: suspected, for probably one in every five women was affected,I though the proportion of cases in which the growth became

malignant was infinitesimal. In the course of his remarks. he considered the question of operative interference in cases

where there were inconvenient symptoms and he stated thatit was his opinion that the operation should be performed

: in all such cases when the patient was young and that the: approach of the menopause was a contra-indication. He. continued by discussing the kind of operation to be per-l formed and stated that he was in favour of suprapubic

hysterectomy. Dr. Haultain concluded by giving an accountof the clinical and pathological aspects of some of his owncases. During the course of his paper he exhibited someinteresting specimens.-Dr. A. C. Geddes moved, and

, Mr. J. D. Wells seconded, a vote of thanks.-Dr. H. N., Fletcher read a dissertation by Dr. Matthews on Tuber-. culous Peritonitis.

. BRISTOL MEDICO-CHIRURGICAL SOCIETY. - Ameeting of this society was held on Feb. 8th, Dr. Reginald

; Eager being in the chair.-Mr. H. F. Mole showed the, following patients and read notes of their cases: (1) an, infant operated on for Spina Bifida at 14 days old; (2) a; case of Ruptured Intestine; (3) a case of Colectomy, &c.,

for Carcinoma of the Colon ; and (4) a case of Excision of the Wrist for Tuberculous Disease.-Dr. J. J. S. Lucas. showed (1) a case of Recovery from Tuberculous Meningitis ;. (2) a case of Exophthalmic Goitre in a man with Glycosuria;, and (3) a speciman of Congenital Malformation of the, Intestine.-Dr. J. M. Fortescue-Brickdale showed a specimen.

of Congenital Dilatation of the Ureter and Cystic Kidneys in achild.-Dr. Theodore Fisher showed a specimen of Chloromaof the Dura Mater, and Dr. J. E. Shaw read the clinical notes

, of the case.-The cases and specimens were discussed by a

: number of the members present.’ PATHOLOGICAL SOCIETY OF MANCHESTER.-A’

meeting of this society was held on Feb. 8th, Dr. T. Harrisbeing in the chair.-Mr. A. J. Rodocanachi showed a VesicalCalculus which he had removed by vaginal lithotomy. It had

; been deposited upon a vulcanite button with which someonehad plugged a vesico-vaginal fistula following hysterectomyand had been forming for over two years.-Dr. Nathan Raw

showed specimens of Lymphosarcoma of the Lungs. Dr.: W. J. S. Bythell and Dr. D. Orr gave a lantern demonstra-

tion of Colour Photography as applied to Pathological His-tology.-Other specimens were shown as card specimens.

’ WEST KENT MEDICO-CHIRURGICAL SOCIETY.-A’ meeting of this society was held at the Royal Kent Dis-

pensary, Greenwich-road, S.E., on Feb. 3rd, Mr. G. ChisholmWilliams, the President, occupying the chair.-Mr. Charles H.Evans of West Norwood and Dr. A. E. Jerman of Erith were

duly elected members of the society.-Mr. E. G. Annis,medical officer of the borough of Greenwich, read a paper

’ on Immunity against Disease.

Reviews and Notices of Books.A 1’ext-bonk of {]Unical Diagnosis by Laboratory Methods.

By L. NAPOLEON BOSTON, Director of the ClinicalLaboratories, Medico-Chirurgical College, Philadelphia.With 320 illustrations, many in colours. London andPhiladelphia : W. B. Saunders and Co. 1905. Pp. 549.Price 18s. net.

THE title on the back of this work hardly conveys an exactidea of its contents, although its sub-title might. It deals

chiefly with microscopical and chemical methods applied tothe study of disease and there is nothing about ausculta-tion, percussion, or other physical methods of this kind. Tosome readers the introductory chapter on the Use of theMicroscope might seem almost unnecessary but of this weneed not complain, for some practitioners to whom this workwill prove of great value may find the hints regarding themethod of using, cleaning, and observing with immersionlenses very useful.

About 150 pages are devoted to the blood under the

following heads : tests for its recognition, estimation